Healthcare Business Growth Conversations

A big practice had $40,000 in insurance checks sitting in a post office, and it went unnoticed. Dr. Heather Signorelli explains how that happens and the daily bank check that catches it.
Dr. Heather Signorelli is a pathologist, physician executive and co-founder of NatRevMD. She moved from running laboratory operations across hospitals into helping independent practices with billing and revenue. She is the author of Thrive, and host of a podcast with over 200 episodes.

When her team started a bank reconciliation for a multi-location practice, they found checks from insurers that had never been deposited, each small enough that no one missed it in a single month.

The insurance company reissued the checks, $40,000 in all. In this episode of Healthcare Business Growth Conversations, she and Rakesh Reddy go through how money goes missing in independent practices and the simple habits that stop it.

In this episode you’ll learn about: 

• The $40,000 in checks found in a post office, and the daily check that finds them: pull the bank receipts, compare them to the EOBs, match and move on

• A phone bill that had grown to $5,000 a month, about ten times what it used to be, and went unnoticed for months

• Why eligibility errors at the front desk are the most common error her team sees

• The monthly metrics a practice owner should never hand off, and what can be delegated

• How “everything looks fine” can hide unauthorized write-offs, credentialing gaps and timely filing problems

• Why billing, the front desk and physicians need a shared accountability loop

• How to tell you are ready to grow, or open a second location

• Her practical first step: pick one thing to learn this month

Connect with Dr. Heather Signorelli:

Spotify: https://open.spotify.com/show/2tkjCQUsqBMOwJzHUx20fS

Apple: https://podcasts.apple.com/us/podcast/natrevmd/id1624182351 

Amazon: https://music.amazon.com/podcasts/8976eef6-80fe-4065-a0e8-3c16595caa4a/natrevmd 

Linkedin: https://linkedin.com/in/hsignorelli    

Website: https://natrevmd.com/  

Facebook: https://www.facebook.com/people/Natrevmd/100083400167763/ 

YouTube: https://www.youtube.com/@NatRevMD/videos 

Instagram: https://www.instagram.com/natrevmd/ 

Most healthcare practices begin with insurance and explore cash pay later. Sharon Lemoine built hers in exactly the opposite direction, and added insurance back in for a reason most owners don't admit out loud.

After 25 years in emergency medicine, Sharon left corporate healthcare and built Gig Harbor Medical Spa and Concierge Medicine from the ground up. She started 100% cash pay, grew a thriving practice, and a few years in added select insurance contracts, not just for community access, but as a hedge against the risk that her cash-paying patients' spending could dry up in a downturn.

In this episode of Healthcare Business Growth Conversations, Sharon explains:
• What running a restaurant through COVID taught her about business
• Why she left corporate emergency medicine
• The advantages and limitations of a cash-pay practice
• Why she really added insurance after several years in business
• What changed operationally when she began accepting insurance (credentialing, software, staffing)
• Why she still doesn't bill Medicare directly
• How word of mouth, Google, and early marketing helped attract patients
• How her concierge membership creates a third, recurring revenue layer
• Why building the right team is critical for scaling without burning out

Reach Sharon Lemoine:

Instagram: https://www.instagram.com/theconciergenp_/

Linkedin: https://www.linkedin.com/in/sharon-lemoine-arnp-fnp-a2529070/

Website: https://gigharbormedicalspa.com/

Most people think healthcare gets better by adding more doctors, more technology, or more hospitals. Dr. Aric Coffman thinks the real problem is the business model behind it.

He spent 17 years as a surgeon before walking away from the operating room. His reason: he kept watching patients fall through the cracks of a system that, in his words, was "sicker than a lot of my patients were." Now he is CEO of P3 Health Partners, a physician-led population health company, and he is fixing a value-based-care business in public, in the middle of a real turnaround.

In this conversation with host Rakesh Reddy, Coffman makes the case that physician burnout is not a personal-resilience problem. It is structural. He calls it moral injury: the slow damage of asking doctors to optimize for volume when everything that pulled them into medicine is about the patient in front of them.

What you'll learn:

• Why he refuses to call it "burnout" and what "moral injury" actually means

• "No one went to medical school to be a winner at RVUs" and why volume-based feedback breaks good doctors

• Why resilience, work-life balance, and meditation are not the fix, and what values congruence is

• The questions a practice owner should actually ask a physician (past the EMR and prior-auth complaints)

• What value-based care means, translated for the doctor listening and not the investor

• The first move a small independent practice can make toward getting paid for outcomes

• Why roughly a quarter of visits, by his gestalt, don't need to happen, and the demand-capacity fix

• How a tiny share of patients drives most of the cost, and how to manage a panel around that

• What P3's comeback taught him, and the hardest call he had to make

• Where AI in primary care is real and where it is still a demo ("augmented intelligence," not artificial)

Whether you own a practice, employ physicians, or are a doctor wondering whether the exhaustion is you or the system, this is the honest version of the value-based-care conversation.

Connect with Dr. Aric Coffman:

Company: P3 Health Partners (NYSE: PIII)

Website: https://p3hp.org/

LinkedIn: https://www.linkedin.com/in/aric-coffman-md-mba-b23b32b/ 

Host: Rakesh Reddy

Podcast: Healthcare Business Growth Conversations

Most practice owners insure their malpractice and their building, then leave the risks most likely to actually disrupt the business completely unprotected. Reputation. Audits. Cyber. Business interruption. A key provider going down.

In this conversation with host Rakesh Reddy, Van Carlson, Founder and CEO of SRA 831(b) Admin, walks through the gaps traditional insurance was never built to cover, using real cases from med spas, dental practices, and specialty clinics.

One of them: a client who got sued after a patient's death, did nothing wrong, and still watched his malpractice carrier settle because, in Van's words, "malpractice is a math problem." The local coverage and the fake reviews that followed took a PR firm and 18 months just to get revenue back to normal.
What you'll learn:

• Why your malpractice and property coverage leave your most valuable assets (reputation, cash flow, patient base) completely exposed
• "Malpractice is a math problem": what your carrier is actually optimizing for, and why it isn't your reputation
• How a Medicare or Medicaid audit disrupts a practice, and the toll it takes on the doctor personally
• The COVID lesson most owners still haven't acted on: business interruption you can't insure the traditional way
• Why cyber policies now carry the most exclusions, including "act of war" language that can void a breach claim
• The blind spot almost no one plans for: losing a key revenue-generating provider
• The 831(b) structure explained simply as "an HSA for business owners," and who it is genuinely NOT a fit for
• The one thing to do this week to find your biggest unprotected risk

This episode is educational and not tax or legal advice. Talk to your own CPA and counsel before making any decision.
Connect with Van Carlson:

• Website: ⁠831b.com⁠
• Email: ⁠[email protected]⁠

Host: Rakesh Reddy
Podcast: Healthcare Business Growth Conversations

Most people buy a business that's already doing well. Dr. Kaori Ema, DDS, MAGD, did the opposite. She acquired a struggling dental practice with a bad reputation, angry former patients, and paper charts, then spent nearly a decade rebuilding it into Printers Row Dental Studio and the cosmetic brand Chicago Veneers.

In this episode of Healthcare Business Growth Conversations, Dr. Ema sits down with host Rakesh to break down what the acquisition really took: the hidden problems no one warned her about, the red flags every buyer should watch for, the insurance and branding decisions that finally grew the practice, and the patient-experience and leadership lessons she learned the hard way.

If you're thinking about buying a practice, building a healthcare brand, or creating a patient experience that actually retains people, this one is packed with hard-won lessons.

———————————————— 

In this episode you’ll learn:

- Why she took on a struggling practice, and what she missed going in

- The single biggest red flag when acquiring a practice (reputation and goodwill)

- "Trust, but verify": doing your own due diligence

- Going out of network and using assignment of benefits to reduce patient friction

- Why she built Chicago Veneers as a separate cosmetic brand

- Managing patient anxiety and why the front desk makes or breaks experience

- Leadership: building, and fixing, the right team

- What keeps her going after a decade of building and rebuilding

———————————————— 

Connect with Dr. Ema:

Website: https://www.prdentalstudio.com/

IG: https://www.instagram.com/chicagoveneers

IG: https://www.instagram.com/smilesbydr.ema 

———————————————— 

ABOUT THE SHOW:

Healthcare Business Growth Conversations, hosted by Rakesh at Orange Carrot Media, features candid conversations with healthcare practice owners on growth, marketing, patient experience, and the reality of running a practice.

Subscribe for new episodes.

Why do brilliant clinicians so often struggle the moment they step into leadership? In this episode, two operators who have spent their careers solving that exact gap sit down to explore it from opposite ends of healthcare.

Dr. Ramzia El Annan built her career as an entrepreneur, opening clinics and training healthcare professionals across the Middle East, Europe, the United States, and Canada. Jack O'Connor spent his career inside hospital systems, building the curriculum for a physician leadership academy that trains VP-level leaders across major hospital chains.

Between them, they name the gap the healthcare system rarely admits: clinical credentials open the door, but leadership requires an entirely different skill set that no medical, nursing, or pharmacy school teaches. This is the honest conversation about what it actually costs when that transition goes wrong, and what it takes to build organizations that outlast individual expertise.

━━━━━━━━━━━━━━━━━━━━━━━━━━━━

ABOUT THE GUESTS
Dr. Ramzia El Annan, PharmD, RPh, CPP, CMAP
Founder and CEO of Ramzderm Medico-Aesthetic Academy and Skin Center. International expert in aesthetic, regenerative, and longevity medicine with clinics and educational programs across four continents.
LinkedIn: https://www.linkedin.com/in/dr-ramzia-annan-pharmd-cpp-cmap-2a1a0620/

Jack O'Connor
Healthcare executive with a career spanning hospital systems and physician leadership development. Built the physician leadership academy curriculum that trains VP-level leaders across major US hospital chains.
LinkedIn: https://www.linkedin.com/in/jack-f-oconnor/

━━━━━━━━━━━━━━━━━━━━━━━━━━━━

ABOUT THE SHOW
Healthcare Business Growth Conversations is hosted by Rakesh Reddy, COO of Orange Carrot Media. Every episode features honest conversations with healthcare operators, clinicians, and executives about what actually drives growth in medical practices, clinics, and healthcare organizations.

Subscribe for new episodes every week: https://youtube.com/@orangecarrotmediafl
Follow Orange Carrot Media:
LinkedIn: https://linkedin.com/company/orange-carrot-media
Instagram: https://www.instagram.com/orangecarrotmedia
Work with Orange Carrot Media:
https://orangecarrotmedia.com

Dr. Ashley Spooner built three businesses without ever leaving her chair.

She owns Falcon Park Dental Group, founded Dynamic Dental Sleep LLC to train dentists in dental sleep medicine, and created Sleep. Thrive. Live. to educate the public. She's also a Diplomate of the American Board of Dental Sleep Medicine, one of roughly 425 in the United States.

In this conversation, she shares how she built authority beyond a single practice, why she bet on dental sleep medicine a decade ago when most dentists thought she was crazy, how she identified an underserved market hiding in plain sight, and how she runs three brands in parallel without burning out.

She also discusses leadership, delegation, building trust with teams, the COVID furlough that reshaped her leadership philosophy, and why she no longer manages out of fear.

If you're a healthcare entrepreneur, practice owner, or clinician looking to grow beyond traditional clinical care, this episode offers a practical look at how to build authority that goes beyond your chair.

Find Dr. Spooner at dynamicdentalsleep.com

Instagram: https://www.instagram.com/sleepthrivelive

YouTube: https://www.youtube.com/@SleepThriveLive

Healthcare Business Growth Conversations is a podcast exploring the business of healthcare. Hosted by Rakesh Reddy and Austin Lovvorn, the show features conversations with doctors, dentists, healthcare executives, and entrepreneurs who share practical insights on growing practices, leading teams, improving operations, and building sustainable healthcare organizations.

Most healthcare practices don't have a growth problem. They have a leakage problem.

Claims that never get paid. Front desks drowning in calls while doctors burn out seeing patients. AR backlogs piling up before timely filing windows close. Most practice owners think they need more patients. The numbers say they're losing money on the patients they already have.

Tim Boyle leads business development at Reva Global Medical, a company that places offshore medical virtual assistants (Philippines-based, HIPAA-certified) inside healthcare practices to plug those leaks. Before this, he played professional hockey. He's seen the inside of dozens of practices and can tell you exactly where the money is bleeding out.

In this conversation with host Rakesh Reddy, Tim breaks down the cost math, the hidden revenue most practices don't know they're losing, and the playbook one diabetes clinic used to bring its no-show rate to 0%.

What you'll learn:

➡️ Why provider burnout is mostly an administrative problem, not a clinical one

➡️ The $80,000 vs $32,000 cost math: in-house medical assistant vs offshore VA

➡️ Why one IVF practice started with one VA and scaled to five

➡️ How a VA found $15,000 in extra revenue for one practice in a single day

➡️ The diabetes clinic that brought its no-show rate from chronic to zero

➡️ The dental practice pre-appointment outreach playbook

➡️ The HIPAA question every practice owner asks (and the real answer)

➡️ What to demand from any VA provider before you sign up

➡️ The one habit every well-run practice has in common

➡️ Where the biggest revenue leaks usually live (front desk vs back-end billing)

Whether you own a small practice, manage a multi-location group, or you're advising clinics on growth, this is the unfiltered look at where healthcare practices actually lose money and what to do about it.

Connect with Tim Boyle and Reva Global Medical:

Website: https://revaglobalmedical.com

Instagram: https://www.instagram.com/revaglobalmedical/

Linkedin: https://www.linkedin.com/company/reva-global-medical

Dr. Alvin Cowans opened Optimum Podiatry during COVID with only 5 patients in his first week. So he got in his car, packed cookies and snacks, and visited 12 doctor offices a day for two months straight. Today his clinic is full and he's opening a larger office in June.

In this conversation with host Rakesh Reddy, Dr. Cowans breaks down exactly what he did, what residency never prepared him for, and what he wishes he had known before opening the doors.

What you'll learn:

1. The exact pitch he used walking into primary care offices, urgent cares, and OBGYN clinics

2. The single biggest skill residency never taught him: leadership, payroll, and running a real business

3. Why hiring for attitude beats hiring for experience, and how spots a bad hire in 2 weeks

4. The systems every clinic should put in place first (front desk and back office)

5. Why he believes insurance-only practices won't survive the next decade

6. The hybrid cash-pay roadmap: 25% by year one, 50% by year ten, 75% long term

7. What he'd do with $10K and zero patients today

8. The one regret he can't shake: "I wish I'd opened 7 years earlier"

Connect with Dr. Alvin Cowans, DPM:

- Website: https://optimumpodiatryga.com⁠

-Instagram: https://www.instagram.com/optimumpodiatry/

-Facebook: https://www.facebook.com/OptimumPodiatry/

-YouTube: https://www.youtube.com/@optimumpodiatry/

Some patients are paying $10,000 cash for surgery their insurance would cover.
Dr. Tek Fish, DPM has friends with clinics across the country doing the same. And he's been quietly building this into his own practice for the last five years.
Why?
Because at a practice management conference five years ago, he heard a line that changed how he thought about the next 20 years of his career:
"How much you get paid today by insurance is the most you will ever get paid for the rest of your career."
Reimbursements have dropped every single year for the last five years. So Dr. Fish stopped waiting for the system to fix itself. He bought one machine, did the math on what one cash patient a month would deliver, and started rebuilding his clinic around a hybrid model.
In this conversation with host Rakesh Reddy, Dr. Fish breaks down the economics, the pricing rule he uses for every cash-pay service, and the mindset shifts most doctors need to make before the math stops working entirely.
What you'll learn:
- Why patients pay $10,000 cash for surgery their insurance would cover (and the math from the patient's side that makes it rational)
- Why insurance reimbursements keep dropping and what that means for solo practitioners
- The first machine to buy if you want to start cash pay
- The 80/50 pricing rule: 80% gross profit, 50% net profit
- Why he charges the same prices in Portland that he'd charge in Detroit
- "Don't decide for the patient if they can afford it" and why this single sentence changes everything
- Why he spent $700,000 on coaching, books, and conferences in five years
- "Money is a tool. Use it." The hard truth most owners refuse to accept
- What practices will thrive over the next 5 years and which ones won't
Whether you're a doctor stuck on insurance reimbursements, a practice owner considering a hybrid model, or anyone curious about the real economics of running a clinic in 2026, this is the unfiltered playbook.

Connect with Dr. Tek Fish, DPM:

Website: https://www.cloverpodiatry.com/

Instagram: https://www.instagram.com/cloverpodiatry/

Linkedin: https://www.linkedin.com/in/tek-fish-a6557137b/